Committee Member Application Form

The WiHMS steering committee members are responsible for long-term strategy and external and public policy for all women in our organization, working collaboratively with the Associate Vice President for Health Equity, Diversity, and Inclusion as well as the Associate Vice President for Health Sciences Education. 

For more information, please visit uofuhealth.utah.edu/inclusion/wihms/

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* 1. Name & Degree(s)

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* 2. Title

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* 3. College

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* 4. Department

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* 5. Phone

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* 6. Email Address

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* 7. Personal Essay – Please share your interest in the position (250 words or less).

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* 8. What is your racial or ethnic identity? (Select all that apply.)

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* 9. What is your gender identity?

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* 10. Curriculum Vitae - Please attach your CV.

PDF, DOC, DOCX file types only.
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* 11. What is your sexual orientation?

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* 12. Do you identify as transgender (or another non-cisgender identity)?

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